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Saturday, July 29, 2017

Republican failure to repeal or replace the Affordable Care Act (a.k.a. Obamacare) is a testament to the staying power of a federal entitlement: once granted, it is extremely difficult to take it away.

The ACA offered to expand Medicaid coverage for low-income families whose income is less than 138% of the federal poverty level (FPL), starting in January 2014. People making up to four times the poverty level, which is $20,420 for a family of three in 2017, could qualify for subsidies to help them buy insurance through the state exchanges. But when the Supreme Court in June 2012 ruled that the federal government couldn’t force the states to expand Medicaid, 25 states where Republicans were in charge took advantage of the court’s permission to refuse the federally-funded expansion. They didn’t care that the rejection of Medicaid expansion would result in 7.78 million people who would have gained coverage remaining uninsured and between 7,115 and 17,104 more people would die annually from treatable illnesses.

Texas was the largest state to opt out of Medicaid expansion, as Republicans blocked more than two million working Texans from getting federally financed health care. The Harvard/CUNY study estimated that between 1,840 and 3,035 Texans’ lives would be lost annually, or as many as 12,000 so far. In Florida, Republicans kept 1.2 million working poor Floridians from getting insurance, which has resulted in between 1,158 and 2,221 deaths annually since then. That puts the lie to the Republican claim to be “pro-life.”

As of 2017, six more states had accepted the expansion, leaving 31 states and D.C. expanding Medicaid while 19 states continue to withhold federally financed health care from the working poor.

The Senate Republican bill would increase the number of uninsured Americans by 14 million in 2018 and 22 million by 2026, the Congressional Budget Office projected. The increase in the number of uninsured would result in 18,100 excess deaths in 2018, 22,900 excess deaths in 2020, and 26,500 extra deaths in 2026, researchers from Harvard’s School of Public Health found, estimating a total of 208,500 unnecessary deaths over the next decade.

A few Republican senators whose states have gotten used to the Medicaid expansion have kept the bill from advancing so far, but if bringing back John McCain in the midst of cancer treatment to cast a vote to throw millions of working stiffs off Medicaid doesn’t do the trick to free up tax cuts for billionaires (as McCain ended up disappointing Majority Leader Mitch McConnell and siding with the Democrats, along with Susan Collins of Maine and Lisa Murkowski of Alaska), Donald Trump has said he favors letting “Obamacare” fail — and in Secretary of Health and Human Services Tom Price, Trump has the right man in place to make sure it fails!

At least Republican fumbling of health care schemes has increased the popularity of Obamacare as well as acceptance of a federal role in making sure all Americans get health care. An Associated Press/NORC poll in July found that 62% of respondents said it was the responsibility of the federal government to make sure that all Americans have health coverage. That was up from 52% in March.

The same poll found a clear majority of 59% wants to keep Obamacare, but 73% of those who want to keep the ACA said it should be changed to work better.

A Kaiser Family Foundation poll in June found 53% supporting all Americans getting their coverage through a single government plan, such as Medicare for All, while 43% were opposed. But a similar poll by Pew Research Center in June found that 33% support a single national government health program, while 25% support a mix of government programs and private insurance.

Democratic leaders appear to be slow to adopt the Medicare for All solution, but HR 676, the bill which Rep. John Conyers (D-Mich.) has filed to expand and improve Medicare for all, has 115 co-sponsors, which is more than one-half of the Democratic caucus and is the highest level of support the bill has received since Conyers started filing the bill in 2003. Among the Medicare for All co-sponsors in the House are Rep. Joseph Crowley (D-Mass.), chairman of the House Democratic Caucus, and Rep. Keith Ellison (D-Minn.), vice chair of the Democratic National Committee. “We can fight fiercely to protect the Affordable Care Act and also look a little bit farther in terms of establishing Medicare for All,” Ellison said in a May press conference.

Sen. Bernie Sanders (I-Vt.) is expected to file his own Medicare for All bill, which will put Democratic senators on the spot.

DNC Chairman Tom Perez has said he supports universal health coverage but he doubts Medicare for All is achievable. “I would love, if I were king for the day, to do something akin to Medicare for all. Because Medicare has been a very good program, and it’s helped a lot of people,” he told NBC’s Seth Myers in May.

House Speaker Nancy Pelosi (D-Calif.) has said the time has not yet come for a push for single-payer on the national level. “The comfort level with a broader base of the American people is not there yet,” Pelosi said in May. Instead, she suggested that Democrats push for a state-level public option for health insurance. “We must defeat the repeal of the Affordable Care Act. But that is not our only fight,” she said. “We must go further! The Affordable Care Act enables every state to create a public option. I believe California can lead the way for America by creating a strong public option.”

Ellison said he thought it would be good politics for Democrats to run on single payer in 2018. “It’s not the proper role of me at the DNC to tell people what they’re going to stand for, that’s a choice the candidates make for themselves, but I recommend that you win your election and I think a good way to do it is to support Conyers’ bill,” Ellison said.

Defenders of the current private insurance system raise fears that Medicare for All would increase taxes, but putting the US on a single-payer system actually could — and should — cut health care costs. We spend more on health per capita than any other nation ($9,403 in 2014), but still left 33 million uninsured. Canada gives everybody up north equal access to medical facilities, practitioners and procedures at a cost of $4,641 per capita. Still, Canada spent far less of its GDP on health care than did the US — 10.4% compared with 17.8% in the US — which, again. was the highest share of any nation, according to the World Health Organization.

Physicians for a National Health Program proposes to expand Medicare to cover all Americans for all medical care, including mental health, dental care and prescription drugs, without deductibles or copays. The system would be publicly financed, but would rely on existing private hospitals, clinics and practitioners to provide care, much like Medicare does. During a transition period, all public funds currently spent on health care – including Medicare, Medicaid and state and local health care programs – would be redirected to the unified National Health Plan budget. Such public spending – together with tax subsidies for employer-paid insurance and government expenditures for public workers’ health benefits – already accounts for 60% of total US health expenditures. Additional funds would be raised through taxes, though PNHP notes that these would be fully offset by a decrease in out-of-pocket spending and private insurance premiums. Also, doing away with private insurance, which averages 12% overhead, and simplifying administrative costs for doctors and hospitals would save more than $400 billion annually.

Medicare for All won’t go anywhere in this current Congress, but Democrats should promote it to give voters a choice that would work for 2018. At least it might motivate Republicans to work with Democrats to fix the Affordable Care Act and stop letting tens of thousands of working people die for lack of medical care.

By the way, when conservatives demand to know where in the Constitution is the authority for the federal government to provide health insurance, the answer is right up front, in the Preamble, where it says one of the reasons to establish the Constitution is to “promote the general Welfare.” Let’s get after it. — JMC

Editor's note: This has been updated from the print version since the 51-49 Senate vote that defeated the "skinny repeal" bill on July 28, which apparently has stalled the Republican "repeal and replace" effort, at least for the time being.

If it weren’t for the entertainment value, I’d be pleased that Texas Governor Rick Perry is foundering in the Republican presidential race. After all, Governor Perry, who is in an unprecedented fourth term as chief executive of the nation's second-largest state, still might get the Republican nomination for president. If that happens there’s no telling what the voters might be fooled into doing. Just look at how far George W. Bush got.